Restoration Therapy: Depression, Self-Care, and Ministry

When serving in ministry there are many opportunities to come in to contact with people who are depressed. I say this, because churches are often what I refer to as the “gatekeepers” in mental health, therefore, those employed or volunteering in ministry are often on the front lines. All of this assumes of course that the church environment that you are a part of doesn’t communicate or perpetuate a stigma around mental health, but instead embraces it. And if your church embraces it then you will have many people come to you and confide about their struggles with depression.

A majority of the people that I work with in my private practice are referred to me by the local church, and it is often ministry leaders who are in the position of assessing whether or not a person has depression, and what steps should ensue. This was a challenge for me when I was the college pastor at Bel Air Presbyterian Church, as I had many conversations with students each day who weren’t exactly coming forward and saying they were depressed, but in hindsight many of them were, I just didn’t have the right tools to make the assessment.

I at least knew that my role on the front lines was to provide a safe environment for them to open up and talk, and if needed, I could make a referral to a therapist. At some point along the way I knew that I needed more training and eventually went back to pursue my Master of Science in Marital and Family Therapy at Fuller Theological Seminary. That eventually led to my transition from full-time ministry into full-time therapy work.

But what about when the depression you are assessing is not just those congregants you come into contact with on a weekly basis who are seeking help, but instead the depression is being manifested in those ministry leaders, pastoral staff, and volunteers around you. What might that look like?

Assessing Depression

There are a variety of factors and tools that one may use in assessing if someone has depression. In ministry, there were usually a few questions I may have asked a student leader to better assess what was going on. I still ask those questions of people in ministry, as well as in my clinical work. In my work as a Marriage and Family Therapist one of the main tools that we use is the DSM-5 (i.e. Diagnostic and Statistical Manual for Mental Disorders). Whether or not one believes in diagnosing individuals, some of the criteria they provide is very helpful in getting a sense of the symptoms that one is exhibiting. My own tendency is to know what the criteria are that make up depression, but to not rush to label someone with some type of diagnostical number that may make them feel they are being reduced to a disorder. Instead, I want to know what depression is, and to be able to talk to people about it in a natural conversation that makes someone feel safe and understood.

As a pastor, leader, or volunteer in the Church you most likely will not look at the criteria in the DSM-5, but it’s important to have a baseline of criteria that one’s symptoms can be measured against. A book that I have found really helpful is Depression and Hope: New Insights for Pastoral Counseling by Howard W. Stone. In this great book Stone says the following:

Depression, or melancholia, is known in psychiatric terminology as major depression to distinguish it from the normal low periods that many people go through. The psychiatric diagnostic criteria for major depression lists nine symptoms, as follows:

Depressed mood, sadness, irritability part of each day, nearly every day

Diminished pleasure or interest in daily activities

Considerable weight loss or gain, change in appetite

Significant change in sleeping patterns (The most common result is early waking.)

Feelings of worthlessness or guilt (The feelings are beyond the scope of how people would usually feel.)

Difficulty in concentration

Ideas of suicide or death

To be diagnosed with major depression according to the American Psychiatric Association criteria, persons must exhibit at least five symptoms for a minimum of two weeks, and have either depressed mood or diminished pleasure or interest on most days for at least part of the day (APA 1994). These criteria are a good basis for determining if someone really is depressed. The certainly are not exhaustive but signal that a person’s story may be one of melancholia. (pp. 65-66)

I find Stone’s criteria for depression helpful, but it can still be tricky at times to really assess what is going on with a person, and whether it is really depression, or some other thing that is being manifested. An example I came across a lot as a college pastor is that I would be working with college student ministry leaders who were under a lot of pressure to perform well in college. They were not only performing well academically, but they were serving in ministry, involved in extracurricular activities at school, they were hanging out with friends, and they may have even held down a job. On top of all of this, they were getting very little sleep. I would often show up to meet them for breakfast and they just seemed down and exhausted. Was that depression? Or was that just exhaustion, and they needed to get some rest? It’s hard to know.

So what are some things we can start paying attention to, to better determine if those in ministry are struggling with depression?

How Does Depression Manifest in Ministry

I think there are many ways that depression manifests itself in ministry, but what I would like to do is mention how in a few different areas I think it has manifested for me on occasion, and then from there I want to share what I often experience as I come into contact with many pastors in the therapy work that I do. The tricky thing with depression and burnout is that we can experience symptoms along the spectrum without being considered clinically depressed. Here is how I experienced it at varying levels:

Physically: Being so exhausted that you I didn’t have the energy for one more event or meeting. In fact, sometimes when I was doing the yearly calendar, my relief would come from looking at the date about 9 months out when I could rest. Now that is depressing.

Emotionally: Not being able to enter into, or handle anymore conversations, meetings, encounters with people in ministry. My fuse was short and I was unable to pay attention at a certain level. It’s an emotional exhaustion. Often this most manifests itself at home with the people we love. We give all we have at work, but have little energy for home. I would be available and patience with my college students and colleagues, only to come home and be short tempered and lacking in grace with my wife.

Mentally: I would not have the mental capacity or energy to read any books that were helpful to my theological growth, or the crafting of my weekly sermons. I would find myself disinterested in learning something new at times.

Spiritually: Not being able to pray or read Scripture. In fact, most of that was masked by ministry prayer (in meetings, services, etc.), but little of my own prayer life. Also, most of my scripture reading was for sermon preparation, but very little of my own prayer devotion and meditation. I think this is very common in ministry, where pastors spend hours upon hours in sermon preparation and consider that to be part of their devotion and meditation.

This is how I often personally experienced depression in some core areas of my personal and ministerial life? Does this resonate with you?

Being Honest With Yourself About Depression

I think it’s safe to say that if you resonate with any of the criteria that Howard Stone mentions above, or if any of my examples above hit close to home, then it’s possible that you are struggling with depression. Or it’s possible that the ministry leader who you have been talking with and hearing similar stories may be struggling themselves. The level of depression could be minimal or it could be great. Whatever the depression it though, it’s important to take some next steps in order to address it.

The first step is to just be honest with yourself and acknowledge that you may have depression, and that there is nothing wrong with you because you struggle. As I have said before, part of being human is struggling with depression at varying times in our lives. So begin by admitting that depression may be at play in your life.

The second step would be to reach out for help from someone who can walk you through depression. This person could be a friend, a pastoral counselor, a marriage and family therapist, a psychiatrist, etc. Depending on what is going on with you and your depression, what you need may vary, so it’s important to be open to that. What’s most critical though is that the person you are talking to or working with has experience in helping people with depression, and preferably experience in helping people with depression in ministry, because this vocation often presents it’s own unique challenges.

The person you work with may suggest different things to help alleviate the depression from cognitive behavioral therapy, to Restoration Therapy, to medication, to meditation, etc, etc. Whatever path for course of treatment is laid out for you, I do think there are some important steps (along with the treatment plan) you can begin to take for yourself that I will discuss next.

Taking Care of the Divine Image

In the gospel of Luke we come across two interesting passages that are helpful for our discussion on depression, because I think they reflect the idea that taking care of ourselves is an important quality since we are made in the image of God (Genesis 1:27).

Both passages embody this idea that there are varying aspects of what makes us…us…and that need to be addressed and attended to. Starting with Jesus we see that Jesus grows physically (stature: this could be both physical height and reputation), emotionally (favor with man), mentally (wisdom), and spiritually (favor with God). And then we see that Jesus commands us to love God with all of our heart (emotionally), soul (spiritually), strength (physically) and mind (mentally).

Though I know there is deeper exegetical work to do here, the point is clear. We are created in God’s image, and because we bear that image there are aspects of us that we have to attend to. And these aspects are so important that we are commanded to love God with all of them, and then to love our neighbor as ourselves. And to love our neighbor means that we start by loving all aspects of this divine image.

So I want to suggest some simple ways that by taking care of you, you also begin by doing some valuable work on your depression. In order to do that I want to suggest that you take care of yourself physically, emotionally, mentally and spiritually:

Physically: Physical self-care involves all aspects of your physical body and life. The most obvious that comes up for people is to begin assessing their exercise, diet and sleep. These three core areas tend to be the most neglected for people when suffering depression, and often you will hear people talk about how they were doing good and then they stopped exercising, and started eating bad, and then sleep got worse, and the next thing they realized is that they were in a depression. And though there are other aspects of physical self-care I tend to focus on these three the most, at least in the beginning when helping people with depression.

Exercise may involve encouraging yourself or others to go out for a walk each day, or start running, or taking a yoga class, or lifting weights. Often when people are depressed they have a hard time motivating themselves to make change. So a good starting point may be, walking around your block 3 days a week, and allow that to build into something else.

Sleep is critical to one’s mental health and people who don’t sleep well, or who sleep little often have a harder time emotionally regulating themselves, which often affects one’s ability to be able to have the ability to manage their depression in an effective way.

So as you navigate your own depression, or help someone through theirs, be talking to them about physical self-care, and really hone in on exercise, diet and sleep.

Emotionally: When I talk about emotional self-care I think about one’s ability to take care of their emotions. That is, the ability to pay particular attention to feelings, and to be able to address them in healthy ways.

Emotional self-care often comes down to several key areas in my work with people with depression.

I focus on helping them create opportunities and habits to emotionally connect with others, which may involve a date night with a spouse, or a girl’s night out with some friends.

It also involves being able to emotionally connect with themselves, which means that they will have to work on creating habits to foster their interior world of feelings. For example, an introvert might need to spend time alone to take care of themselves emotionally, while an extrovert might want to go out with a friend. Ultimately, in this area of self-care I want them to think about what they need to do to take care of their heart.

Mentally: Mental self-care is the things that we do to foster our intellect. Essentially, growing our minds. In this area of self-care I recommend things like reading a book, listening to a podcast, taking a class, or pursuing a hobby that engages the mental faculties.

Spiritually: Spiritual self-care is the things that we do that help us foster our connection with God, and this can be varying for people. Some people may talk about prayer, and prayer may look very different to each person. Others may talk about worship, and when they think of worship they are talking about music. While others talk about the importance of small groups and church community in the fostering of their spiritual life. The goal is to think about what is a spiritual exercise that helps you, or the person you are working with, best connect to God.

After I assess the self-care piece with people struggling with depression, I usually ask them to make a list of as many things in each category that interest them. After they make that list I narrow it down again and ask them to pick only one activity in each category. After they have done this I may narrow it down again and ask them, “Are these four exercises of self-care (one in each category) things that you are capable of doing on a weekly basis, or should we just focus on one thing total in the four areas combined?”

I tell people that the goal is not to necessarily do every self-care exercise everyday, but instead to be able to create a healthy rhythm, so that when they reflect back on their week they notice they have been taking care of themselves physically, emotionally, mentally and spiritually.

A good way to frame this exercise is to take out a piece of paper and draw three lines down the paper vertically, creating four columns. In column one (starting on the left), write physical. Column two, write emotional,, etc, etc. And begin to write the different pieces of self-care in the appropriate columns. I find that this visual exercise is very helpful for many people.

Assess and Practice

For those of you in ministry positions (and those who are not as well), I encourage you to keep an eye out for people around you suffering from depression. Churches as I mentioned earlier are often the “gatekeepers” and on the front lines to help people with depression. But also be aware that depression is just not something “out there” in the congregation, but is very common among church staffs and in ministry leaders, whether employed by the church or volunteer. And ultimately, pay attention to yourself, for one day you might find yourself struggling with depression and you will need to follow the path of advice that you gave to many people before you.

Last, trust that you have been given the the adequate skills to help assess if someone may have depression, and you may be able to help them practice the important piece of self-care. But know yourself well enough to know when to refer someone out to a person who works with people with depression for a living. If you follow these simple steps I believe you will be successful in this battle with mental health in ministry.